HIV/AIDS and Lipodystrophy Treatments Part I: Treatments for Fat Gain

Introduction

Fat is needed for the body to function. It plays an important role in
keeping the skin and hair healthy, protecting body organs, and maintaining body
temperature. Fat is also stored to use for energy.

There are different types of fat found in the body. Visceral fat is located
deep in the belly under the muscle. Subcutaneous fat is the layer of fat just
under the skin. Lipids are fats or fat-like substances in the blood, such as
cholesterol and triglycerides.

Lipodystrophy means abnormal fat changes. It is used to describe a number of
potentially unhealthy changes including:

Body shape changes

Lipohypertrophy: Fat gain in the breasts or back of the neck (buffalo
hump); visceral fat gain in the belly; round lumps that appear under the skin
(lipomas)

People living with HIV (HIV+) who have lipodystrophy can have both body shape changes and
metabolic problems. Some treatments can help with certain lipodystrophy
changes, but no existing treatment gets rid of them all.

Treatments for Fat Gain

Fat gain, especially visceral fat in the belly, can cause a number of
problems. First, belly fat can make people feel badly about how their bodies
look and can lead to depression. Many people living with HIV believe that the fat gain or fat
loss of lipodystrophy marks them as HIV+ and increases the stigma they face.
Second, additional belly fat can lead to bloating, tiredness, and heart
problems. Fat gain can not only affect the way you look, but also be harmful to your health.

No one is really sure what causes fat gain in people living with HIV.
Sometimes it happens when a person puts on weight because of lack of exercise
or getting older. However, fat gain may also be linked to the use of certain
HIV drugs, including protease inhibitors. There are several treatments being
explored for HIV-related fat gain.

Human Growth Hormone

Human growth hormone (HGH) is naturally produced in the human body. Two
drugs have been developed based on HGH that have shown the ability to reduce
visceral belly fat:

Serostim (somatropin): This drug is a synthetic (made in a laboratory) version of HGH

Egrifta (tesamorelin): This drug is a synthetic growth hormone releasing
factor, which causes the body to produce more HGH

Serostim is taken by injecting it under the skin every day or every-other-day.
If the drug is stopped, the visceral fat comes back. The main side effects are
joint aches, excess water held in the body, increased lipoatrophy, and increased blood sugar
levels, including diabetes.

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Serostim is approved by the US Food and Drug Administration (FDA) to treat HIV
wasting (unwanted loss of body mass or size), but not HIV-related fat lipodystrophy. The FDA said there was not
enough safety and efficacy data to approve it to treat lipodystrophy,
especially for long-term use.

Egrifta has also been shown to decrease visceral belly fat. Like Serostim,
people who stopped Egrifta had their belly fat return. Egrifta requires daily
injections, but seems to have milder side effects than Serostim. It does not
increase blood sugar or cause lipoatrophy, and it may lower triglycerides.

Over-the counter nutritional human growth hormone supplements are often
advertised. Beware of these -- there is neither proof that they work nor proof
that they are safe.

Leptin

Leptin is a hormone that is produced by fat cells. High levels of leptin
suppress appetite and cause more fat to be used up.

Leptin treatment requires two injections under the skin a day, although
other doses may be studied in the future. In a small trial of HIV+ men with
lipodystrophy, visceral fat decreased by almost one third after six months, with no
change in subcutaneous fat. Small studies have not shown leptin to have
negative effects on blood sugar.

This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

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